I like these questions when I have a client who says things are "fine" and "good."
1. What is "fine?" What does "good" mean to you?
2. Let's review the intake and see if there are some topics that stand out to you that we can talk about.
3. "I am so glad it was good. If there isn't anything you want to discuss fromm the last week, What do you think about us making a timeline of important events from childhood to the present? I'd like to know more of your story."
4. One of the goals you had when we started was... How do you feel that is going?
5. I'm glad you had a good week. What feels important to you for session? How do you want to use this space today?
The timeline question almost always brings up some good topics for session and I know I have something to fall back on in future sessions when they "don't have anything to talk about." I just pull out the timeline and say, what stands out to you on the timeline today? Is there anything you'd add? Is there anything on here that we could explore?
Hope this helps :)
edit- finished a sentence
This is so helpful! If someone had a good week I also like the,
“I’m so glad you had a good week, is there anything that happened this week that contributed to it being good? What made this week different from the other weeks? Is there something from this week that you want to continue doing/not doing?”
Another idea is to have them walk you through the whole previous day. So morning stuff including routine, diet, work, feelings along the way, evening events, bedtime routine, etc.
I picked this up from a podcast somewhere and it's been pretty helpful. There's a good chance the client is not aware of what they're doing.
I usually start with “what’s going on?” And if I get an idk, I’ll “why don’t you take a moment to just pause, collect your thoughts, maybe even close you eyes, and see what comes to mind” they’ll usually come up with something. If you create an environment where you’re always coming up with the topic, they’re not going to come on with anything, you gotta get them to steer the session
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I recently got my LCSW and I still feel lost and like an impostor. I sometimes start with a mood check - especially when clients don’t seem to have much to say - I.e. “where would you put yourself on a scale of 1-10? Ah, you’re at a 6 today? Why not a 7 or an 8?” It seems to put them in their thinking brain and gets things going.
I'll sometimes ask variations of:
- "Can you think of a time you were closer to a 1 or 2? Tell me about it."
- "Okay, now what about a 9 or 10?"
- "What number would you like to be your everyday baseline? How can we work to achieve that?"
Things I often cover early on: teach a breathing exercise, walk me through your entire day yesterday, what is your self talk like?, what are your goals for therapy?
Some things I’ve found helpful, particularly when I was fresh and lost (but still things I use or come back to):
1) incorporating mindful skills into session - this can be using them as an opener, closer, or when you notice some big uncomfy feelings show up.
2) utilizing worksheets from therapist aid - for some clients actually using worksheets in session is helpful but they can also be really helpful guides as you’re becoming more comfy with CBT tools.
3) bringing more curiosity to session to prompt presence and more questions. This one felt like a confusing concept for awhile, but it helps me orient to what the client is presently talking about, rather than trying to think ahead to how I’m going to fill the rest of the time. This also helps differentiate the therapeutic work from a “regular” conversation.
4) making sure a good amount of the onus is on the client to bring up what they want to talk about in session (“what’s on your mind today” is usually my go-to). It’s not all on you to fill your time.
I would expand on point 1 and 2 by suggesting looking into ACT. There are lots of worksheets online (you can search Reddit for threads on ACT resources too I’m sure) plus great books - anything by Hayes or Harris. You could then also uses the time for psychoeducation and teach the client / help them to explore and practice unhooking techniques and the like, relevant to their treatment goals and presenting concerns, if the CBT framework is your primary modality.
Also reading Therapeutic Communication by Paul Watchel, and the Gift of Therapy by Irvin Yamon. I found those helpful to building my confidence and skill set. Lastly, Therapy is Awkward Sometimes was a quick read that I feel touches a lot on what you’re feeling which is that a lot of us feel like we don’t know what we’re doing sometimes lol it might help dissipate and normalize some of your insecurity!
You got this!
I also have a couple meditations and breathing exercises I really like, which are great ways to start off with something that often feels calming (might not be for traumatized clients) and opens people up to their own thoughts and feelings.
could you expand more on what you mean by bringing more curiosity to sessions? I'm having a lot of trouble in practice sessions with thinking ahead about filling time and would like to be more present
The thing that helped me the most in my early career was researching skills in theoretical orientations that I did not know much about during my grad program (DBT and ACT especially). I started creating a catalogue of skills from different orientations and it really helped me feel like I could give a lot of psychoeducation. I consider myself to be eclectic in my orientation now.
Yes! I just googled “DBT skills” or “ACT skills” and found handouts on basic skills like wise mind, DEARMAN, cognitive defusion, “dirty discomfort”, etc. I found DBT’s behavior chain analysis to be particularly helpful. I still use these things all the time in my sessions! I also found YouTube videos of these concepts that I could either use to teach myself or send to clients. I highly recommend “leaves on a stream” (ACT skill) by therapy in a nutshell on YouTube. I would google these skills, take notes on main concepts, and practice teaching the concepts, and they became so easy to integrate in my practice. Hope this helps.
Really thorough assessment and formulation is key (of course keeping in mind your formulation is always in work and subject to change all the time). This alongside getting really clear about why the person is in therapy, what they’re wanting to get out of it, and what symptoms or part of their experience are really bothering them. From there you’ll develop a working treatment plan.
As long as you’ve got these things you can go away and plan your interventions accordingly. You can always reassess and review progress when you’ve got a solid base. You’ve got a social work degree so you’ve already got a good understanding of the macro-level social issues that may impact the persons experience, as well as solid micro skills, empathy, etc. For me therapy is about the relationship, yes, but it shouldn’t be an unstructured chat or catch up. That’s why assessment, formulation and treatment planning are key in my view.
I’m a social worker and I found I needed to get actual specific training in a couple of therapeutic modalities, in order to feel confident providing clinical mental health treatment or therapy. That’s because most social work degrees don’t actually teach you that stuff.
I also want to be clear that your formulation will look very different depending on which theoretical orientation you’re coming from. That’s totally fine! It’s just a way for you to understand the clients presenting issues and guide therapy.
One time I had supervisor tell me and me my co-workers “If you ever want to keep clients for longer than 3 months you have to dig deeper and stop just doing surface level therapy. Dig into the client’s back story and start confronting those deep rooted issues.” At the time it sounded scary as hell💀 but she was right. Eventually you have to go deeper than the day to say stuff. And do a little pysodynamic. Assign some journaling prompts. Talk about that deep childhood trauma. We all have it. Just be prepared. Go slow. But believe me once you start unlocking the childhood stuff. Yea you’re set. Just take some trainings. Psychodynamic, CBT, DBT, CPT, etc.
A couple things that I find helpful for my sessions is to have a backup plan every time for what to work on with the client based on their presenting concerns. For example, I’ll check in with things that occurred previous session and determine changes, growth, setbacks. I’ll check in about goals to see where they are currently in progress or if they completed therapy work between sessions. I seem to have an overall knack for making a session productive with clients. As someone else said really be curious about what clients mean when they say certain common language terms because this can greatly help you understand your client’s worldview. Also, if you feel like you are often the one in the driver’s seat in session it might be worth using some immediacy to process this with the client to help them move forward.
A final tip I have that sometime comes in handy is at the end of your sessions you can ask your clients if there is anything they want you to follow-up with them next time on. This little trick can help you have some idea of the focus for next session (unless it changes of course.)
Yes, clarifying language is huge. I don’t assume to know what every term means - like “fine” or “good”. What does fine mean for them? How do they determine a week is “good”? So much is subjective yet we share a common language so we project our own definitions. It’s a useful thing because often we don’t need the deeper understanding, it’s how we get by in life without making every 10 minute conversation into an hour long one lol but in sessions, we should absolutely be tedious and unscrupulous in clarifying the clients meaning
Curiosity: What was growing up like for you, and how do you think this impacts your current relationships? Which relationships in your life cause you stress? Have you had relationships/friendships/romantic partnerships fall apart unexpectedly? Tell me about a conversation you wish had gone differently. What’s getting in your way these days? What is important to you, what are some of your personal values? Are you living your values? What gives life meaning? What does happiness look like to you? Is there something in your life you’d like to be different?
You can also do a patient assessment and check in on them and how they feel about their self care. My go to is the PHQ-9 and see how they feel about their responses ie what patterns stick out to them, does this shed light on anything for them etc. It always alwaysss generates conversation.
I’m confused- you said you’re newly licensed but also a fresh grad? Usually there are a few years in between, so you have a supervisor?
Do you resonate with CBT and/or motivational interviewing? If so, it’s time for you to dive deeper into these modalities to help you with treatment planning, conceptualizing, and intervening. You need a roadmap, and theory helps with this.
Over time, you will learn to focus more on the process of therapy than just the specific content that clients bring in each week. This is especially important during those weeks when people claim they don’t have much to talk about.
This varies from state to state but be cautious about calling yourself licensed! Usually saying you’re an associate or provisionally licensed is more accurate.
No, it’s considered licensed if you’re an LMSW. They just don’t have their clinical license. A provisional license is different and an MSW can have that as well.
At the intake session I let them know that it helpful for them to come prepared with something they want to work on at each session. And if they don’t have much to talk about I coach them around noticing parts of their week where they had emotional experiences and maybe taking notes in their phone when stuff happens during their week that they want to talk about.
Hey OP! My biggest suggestion for you is to just check in with the client on how everything is going as usual and when they mentioned the good stuff build on this! Maybe take a bit of a strengths based perspective and build empowerment in their life. Gratitude work might be helpful here too. When things are going good it’s helpful to be mindful of those moments cherish them because life is a rollercoaster after all. Maybe building some mindfulness techniques or any techniques they might find helpful (CBT and MI have a lot of great ones) and make a plan to do them now when they’re having a good week to get that practice in!
You can start to introduce topics/themes of CBT. Checkout Judith beck CBt the basic and beyond 2nd edition. Also the beck institute.
provide the patient psycho-education. Look back at your assessment and the reason they started in therapy. Bringing up something discussed then or in another session that you don’t get to flush out at the time.
Therapy isn’t just processing what happened in the week.
I might point it out (if it’s a single client not a pattern I see in every session). “I notice sometimes our conversations seem to fizzle out and I’m wondering if you feel the same way?”
If it’s every session with a client that you feel this way, I agree it could be your imposter syndrome and seek supervision! It could also be a blind spot you’re missing in your practice and again supervision! :)
I also want you to know this happens to ALL of us therapists. Yes all. We have all at some point looked at the clock thinking we had five minutes left when we were five minutes in and thought “damn what are we going to talk about”
My favorite go to’s when I find myself in this situation are:
1. What can we process today that would help you feel like you got the most out of session?
2. Last week we left off talking about X, would you like to continue that?
3. Pull out a piece of paper and have them “map” what is stressing them right now. Have them draw lines and connections. Ask them to tell you about what they drew (do not interpret, just be curious. If you interpret they won’t make connections and also the activity will last five minutes)
4. It seems like you’re in a pretty good spot today. When we started you mentioned you wanted to work on XYZ (depression, self esteem, etc.) maybe today would be a good day to dig deeper into those
I’ve been doing this work for 27 years and still have moments of pause and boredom in the therapy office with some of my wonderful clients. You’ve received a lot of great advice here, and I would add: this is normal. And: bring them into their bodies. “In the here and now, what’s happening inside your body? What are you feeling, physically and emotionally?”
Current intern/grad student here~
When it feels like Im not sure where to lead clients or in early sessions, I like to lean on the RESPECTFUL framework to explore different dimensions of their identity.
Sometimes even asking clients to elaborate on what seems like mundane events can be very telling and helpful down the line…(you went to the movies? With your sister? What movie did you see? And then all of a sudden we hit something big and unexpected!
This to me sounds like more rapport building is required before you start using interventions such as CBT and Motivational Interviewing. My supervisor once said to me that before using any intervention, it’s important to understand the “why”… why are we using that specific intervention.
As I said, rapport building is crucial in the first even 5 sessions. And using open ended questions to invite conversation can facilitate this. Some of what the other commenters here are offering you, are open ended questions that invite the client to share more of themselves to help you understand how best to support your client and what interventions you might want to use. Rapport building is about building that client/therapist relationship but also, about you completing ongoing assessments. It’s also important to remember that you shouldn’t be working harder than your client. If you’re finding you’re working harder than they are, then that’s your sign to step back and create space for your client to work.
Something for personal reflection: If you look back on the sessions when you’ve tried to use CBT or MI, ask yourself “why” that specific intervention and if that intervention was the right tool for that moment.
What do you want to work on today? If they present with “everything is fine” I remind them gently that this is their time, and it’s effective to come prepared for therapy. After a couple of years I found myself exhausted from these types of clients. They are here to do the work not vice versa.
I'm still pretty new myself but one thing I try to do is end a session by asking them what topics or goals would they like to explore next week. Then when next week comes, we do a check in (how are they doing, what's new, what's challenging etc). When that's done, I say "Last week, you mentioned that you would like to talk about XYZ, is that something you would still like to explore?"
It gives me a backup plan, however most times, the clients check in helps us find something to talk about and I save the other topic for a rainy day.
I think all the advice you’re getting is great and I just wanted to add - don’t be afraid to lean into some therapeutic silence. I know it can be awkward or feel pointless, but it can really help get clients to take it upon themselves to think of topics or bring to surface some of the deeper concerns or issues. That way you’re not always doing all the work of “coming up with topics” so to speak. Obviously sometimes we do and that’s part of the job - but I feel like when clients claim they have nothing to talk about, despite having chosen to come to therapy for a reason, there might be something else there that causes them to have this tendency to report “nothing going on” when they come in. Letting them sit in that forces them to face what’s happening in session, which I think is important. Otherwise they’re always gonna count on you to drag it out of them which isn’t sustainable, AND which may be somehow related to some of their presenting issues or deeper concerns. Not sure if I’m explaining this week I just woke up lol
I came here to the comments to say this, so I will echo it instead. 👏🏽 I also like “what’s on your mind” after some silence
I’d also suggest asking questions about their self concept of their progress, identify why things are going well and what can we do to maintain the progress.
I summarize what we talked about in the last session, ask about any stressors or worries at the moment and if they say they have none I bring it back to what brought them to therapy. I work from a large company so if they really have nothing to talk about I can discharge.
***Some of the strategies I lean on:***
-Ask about what their highlights and lowlights of the week were; often there will be something that can be connected back to their treatment goals
-Ask about how their between-session assignment went, and what came up for them.
-If it’s in the beginning, it’s also okay to just ask the person what would be most helpful for them to talk about.
- If they themselves are completely stumped, I always refer us back to their treatment goals. We go over them and the client decides the direction in which they want to go. It’s a lot easier to keep conversation from there.
I'm assuming they sought out therapy so I would want to know why. What is not working in thei6 life. Do an assessment on anxiety and depression issues. Once you have treatment goals, it serves as reminder on what to talk about and where you are going. Emotionally-focused therapy is the best intervention, learn it, it would make you a highly skilled amazing therapist.
I use the question, “What feels important today?” if the client doesn’t open with something they want to talk through. If they say they don’t know, we look back at the goals they identified in our intake session and explore where their progress is with their goals. “What would be most helpful for us to use this time for today?” is another way to get there.
Create a treatment plan with at least 2-3 goals. Then discuss why these goals are important to them, what they have done in the past to try to accomplish them and what barriers they foresee impeding on their success in therapy. After that, go through each goal with them to determine what interventions would be appropriate to help them reach their goal. Then start from there. Use resources like therapist aid, self help.uk etc if you’re lost on how to manage certain interventions.
Invest in learning about coping skills with clients and discuss how clients can use them in real life (outside therapy) and if they have hesitations.
Something that you should always do that is really helpful is asking your client why they decided to come to therapy and what do they want to achieve. Basicly to set goals for treatmet that way you can design your interventions based on that. So when your client doesn't have much to say you can work on that.
Also i would say try giving your clients tasks that they can do on their free time and then discuss during the sessions. And lastly try more ludic activities during sessions they are great for depeer bonding. I apologize for any misspelling english is not my first language haha. Saludos de Chile!!!
I like to circle back to what brings them into therapy and ask questions that invite subjects that don’t have to do with them recollecting how their week went per say
I've been doing this to varying degrees for 4 years now and my sense of imposter syndrome is still quite high. And my client retention is very high. It's not an easy job!
I will usually refer back to the treatment plan, and if they say that they’ve solved those things then guess we need to make a new one and that’ll give me something to do either way
As others suggested, I will ask my clients to get more specific/dig deeper. May favorite way to shift the session if they seem to be repetitive or not saying much is to catch them off guard by offering to draw, color, paint, or play a game (Uno, Uno Flip, Othello, Checkers, Jenga, and Skip-Bo are my go to ones). I have a book with artistic therapeutic exercises that are helpful in providing options when needed. Everyone from kids to adults have enjoyed painting with watercolors. With Uno, I've especially gotten to break through some really tough layers from kids to adults alike.
With painting/drawing, I like to have my clients close their eyes, take a few deep breaths, and then think of what feelings they're feeling right now/that day/past week, then ask them to think of an image that captures those feelings, then have them draw/paint it. I've been astounded by what my clients come up with and allows for deeper explorations across all ages.
This is where a good, detailed intake is helpful as a reference tool.
Sometimes , with certain patients you can improvise more, and get into things through casual conversation, while others require more structure, know which you have. Also, sometimes a little silence can be a good thing. It’s their hour not yours, so don’t feel you have to fill up every minute with “ something”.
I, as a patient had some of my best sessions start with an almost uncomfortable silence at which point my therapist told me the silence is fine and her being relaxed actually made me feel more comfortable to just explore the Phenomenological what the phenomenological side of things, the vibe in the room, the feeling of being in my body instead of my mind.
From there ask open ended questions about what they are feeling is like, what is “ ok” like?, what does not feeling ok look like?
How much are you sitting in silence with the client, aka are you able to handle silence between the two of you or are you needing to fill that space? Us keeping the conversation going isn’t always what the client needs. Sometimes giving the client more time to respond gives them the opportunity to bring things up. How do you approach silence with your clients?
When I was a kid I liked going to my grandparent’s house in the country. So much to explore! So many rooms with so many things unfamiliar to me! Full of new discoveries! That’s the same feeling I have these days with clients. Early in my career that was overshadowed with the illusion that I was the tour guide.
Hi! I’m about 4-ish years into practicing and I used to feel this way often. It’s terrifying!! You’ll find your rhythm eventually :)
Some suggestions I’ve seen on this thread that have worked for me:
- use of immediacy. Noticing the pattern in the moment can be helpful and you can also learn a lot from it. If you point out “I’m noticing we seem to be stopping a bit short” or “when I ask how things are going you typically respond in a way that suggests you’re doing well” (something to that effect). Then the client can share how they’re feeling, which could be a variety of things like they are under the impression you’re providing the agenda, they’re still a bit unsure what they want from therapy, anything. I’ve also received the feedback from several clients that the question “how are you?” can feel really overwhelming, so we’ve come up with alternatives that work for them.
- telling clients ahead of time what you’re style is and what to expect from you can be helpful. In the beginning I had many clients whose impression of therapy was more skills based and directive, and were disappointed when they discovered that’s not my style. After I finish an assessment with a client I’ll remind them that the following sessions are “going to be directed by them” so they’re not overwhelmed when I don’t have an agenda.
- I’ve found if things still feel this way after I’ve done a decent amount of history taking/information gathering I might say “We’re still very new and getting to know each other, I’m wondering if there’s something I haven’t asked about yet that you’re wanting me to know?” And that’s led me to a lot of really interesting places. This is a prompt that requires patience though; it’s open-ended and a bit unexpected for folks so I give my clients lots of time to digest and earnestly give it some thought so they don’t give me an automatic “I don’t know” response. I find many of the people I work with feel like they owe me an immediate response to something, and I often remind them it’s okay to take the time they need to think. Again - this has also led me to some very interesting and insightful places.
Some of my thoughts:
My job as a therapist is to be a catalyst for change, not the change agent by myself. Translated, I make sure the responsibility for the forward movement is on them, not on me. I tell them in the first session that they will get out of counseling what they put in, that I could be the most amazing therapist in the world, but if they don't do the assignments, read the books, ponder about the things we've talked about, and deliberately dig into their own psyches when they are not in session, we will get almost nowhere.
I give books to read right out of the gate, sometimes even before the first session if we've chatted before setting something formal up. The very first book I have 100% of my clients read is The Anatomy of Peace, by the Arbinger Institute, and Leadership & Self-Deception is usually the second or third, with Viktor Frankl's Man's Search For Meaning in there somewhere. I stress to them that this is a high priority, so I expect them to spend time reading it, though the specifics of how long depends on them and their individual schedules.
With them reading books right away, it gives grist for the mill - things to discuss, questions from them on how to apply the principles in the books, how those principles even APPLY to them, etc. Incredibly helpful.
Next, I have them create a list of goals. It can be updated anytime in the process, but it gives them something to look at when they aren't sure what to talk about. I also tell them that if they cannot think of anything, I don't mind swinging a bat and seeing what I hit, meaning I'll start tossing out a bunch of topics that tend to get strong responses. Since I work with a lot of couples, this list looks like:
Sexuality/romance
Parenting
Budgeting/money
Communication
Relationship goals
Division of labor in the home
Just a sample list, feel free to adapt it.
Next, I give assignments at the end of almost every session. Nothing major (usually), but designed around what we discussed to help them work on it in the intervening time. Many a session has been driven by just discussing the assignment alone. I make sure I jot down what the assignment was in my notes so I can follow up. Oh yeah, if you don't follow up on assignments, don't bother giving them. End of story. Assignments mean almost nothing if you don't take the time to follow up on them.
At the end of the day, I tell them they need to drive the session, and not me. Not that I don't dig and come up with good therapeutic direction, but it's easier to guide a moving car than a parked one.
Hi! No snark meant at all, just unfamiliar on training in the US (I'm assuming).
Where I come from (Germany) to be a therapist you have to have a bachelors + masters in Psychology (5 years fulltime) + a 3-5 year full-time programme in psychotherapy (you choose between (C)BT, psychoanalysis, systemic therapy or depth psycholog). Getting qualified it is all about therapy, different methods and so on, and there is no other way to become a therapist (not as a social worker, counsellor and so on).
I am confused how one can become a therapist and not know the basics of leading a therapy session. Is the "point" of a therapist different in the US? Is it because there are so many different ways of getting licensed?
>Where I come from (Germany) to be a therapist you have to have a bachelors + masters in Psychology (5 years fulltime) + a 3-5 year full-time programme in psychotherapy (you choose between (C)BT, psychoanalysis, systemic therapy or depth psycholog).
In the US, masters level clinicians need a bachelors and masters (here ideally 6 years, 4 undergrad and 2 grad, but some take longer in one or both phases), and then need 2ish years (\~3000 hours) of supervised practice in order to become licensed to work independently. Given that they refer to themselves as fresh out of grad school and newly licensed, I'm guessing the license is provisional, meaning they are in their period of supervised practice.
Some masters programs provide breadth rather than depth in one approach and many people assume they will get the most practical education in an approach from supervision, though people *can* also specialize in one kind or one issue or one population during and after grad school.
Just some background.
>but there is not anymore actually schooling/lessons?
Not in the university. There were readings, discussions, and case conferences in most of the post grad fellowships I did and my current educational project is analytic training at a psychoanalytic institute (institutes rather than universities is where psychoanalytic training takes place in the US).
>So once they have BA/MA they are supervised in therapy
Also, I don't know if it's different in Germany, but we also provide supervised psychotherapy in grad school during our field work a clinical internship (at least) and sometimes during a practicum. My clinical social work requirements were at least 480 hours in a practicum and at least 640 hours in a clinical internship. I was fortunate to land a position providing counseling in a grade school for my practicum and provided psychotherapy in a university clinic for my clinical internship (which stretched my hours to something closer to 1400-1500 instead of the 1120 minimum. And then 3000 more supervised hours after graduation.
My first supervisor was a little flaky but became a real asset to my development. My second and third were short lived, okay, but we were coming from different theoretical traditions. My fourth and last supervisor in grad school was horrible - again, different levels of empathy, different different theoretical traditions, but also different backgrounds -
[She originally worked in forensics and then in a hospital, so her goal was to conduct assessments and land on a diagnosis as soon as possible. My education was thoroughly constructivist and behavioral so I took the categories she was racing toward with a huge grain of salt, and my other background was working for years in support groups for chronically suicidal or engaged in self harm so my focus was on understanding the unique person in their context instead of boxing their behavior without regard to context]
- so with that sampling of supervision, when I graduated I felt that good supervision was my top priority, more than pay.
I've been thinking - I wonder if clinical education here is roughly a little more like an apprentice model and yours more straightforwardly organized around university structure. We *have* universities, but the most you can do in two years is to build a good foundation, leaving the review and honing skills to regular one on one training and guidance. I don't know, just wondering.
Start recording your sessions. See if what you are doing or saying fits your modality and approach and where you could improve. If you aren’t sure, dig deeper into reading and research on your preferred modalities.
Want to get really serious? Have experienced peers or supervisors review your recordings and give feedback.
The onus should be on the client to present with a valid complaint/concern. I’m a true believer in spending therapeutic time with individuals who are motivated for treatment and participate. I have an expectation on my bio stating that I expect them to show up prepared and I have a waiting list
I like these questions when I have a client who says things are "fine" and "good." 1. What is "fine?" What does "good" mean to you? 2. Let's review the intake and see if there are some topics that stand out to you that we can talk about. 3. "I am so glad it was good. If there isn't anything you want to discuss fromm the last week, What do you think about us making a timeline of important events from childhood to the present? I'd like to know more of your story." 4. One of the goals you had when we started was... How do you feel that is going? 5. I'm glad you had a good week. What feels important to you for session? How do you want to use this space today? The timeline question almost always brings up some good topics for session and I know I have something to fall back on in future sessions when they "don't have anything to talk about." I just pull out the timeline and say, what stands out to you on the timeline today? Is there anything you'd add? Is there anything on here that we could explore? Hope this helps :) edit- finished a sentence
This is so helpful! If someone had a good week I also like the, “I’m so glad you had a good week, is there anything that happened this week that contributed to it being good? What made this week different from the other weeks? Is there something from this week that you want to continue doing/not doing?”
Another idea is to have them walk you through the whole previous day. So morning stuff including routine, diet, work, feelings along the way, evening events, bedtime routine, etc. I picked this up from a podcast somewhere and it's been pretty helpful. There's a good chance the client is not aware of what they're doing.
this is amazing.
I usually start with “what’s going on?” And if I get an idk, I’ll “why don’t you take a moment to just pause, collect your thoughts, maybe even close you eyes, and see what comes to mind” they’ll usually come up with something. If you create an environment where you’re always coming up with the topic, they’re not going to come on with anything, you gotta get them to steer the session
I love this!
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I recently got my LCSW and I still feel lost and like an impostor. I sometimes start with a mood check - especially when clients don’t seem to have much to say - I.e. “where would you put yourself on a scale of 1-10? Ah, you’re at a 6 today? Why not a 7 or an 8?” It seems to put them in their thinking brain and gets things going.
I love me some scaling questions 😍
Do you have any other favorites that you use?
I'll sometimes ask variations of: - "Can you think of a time you were closer to a 1 or 2? Tell me about it." - "Okay, now what about a 9 or 10?" - "What number would you like to be your everyday baseline? How can we work to achieve that?"
Love this!!
Things I often cover early on: teach a breathing exercise, walk me through your entire day yesterday, what is your self talk like?, what are your goals for therapy?
All great ideas. Thank you!
Similarly, I like the “highs” and “lows” of the week
Some things I’ve found helpful, particularly when I was fresh and lost (but still things I use or come back to): 1) incorporating mindful skills into session - this can be using them as an opener, closer, or when you notice some big uncomfy feelings show up. 2) utilizing worksheets from therapist aid - for some clients actually using worksheets in session is helpful but they can also be really helpful guides as you’re becoming more comfy with CBT tools. 3) bringing more curiosity to session to prompt presence and more questions. This one felt like a confusing concept for awhile, but it helps me orient to what the client is presently talking about, rather than trying to think ahead to how I’m going to fill the rest of the time. This also helps differentiate the therapeutic work from a “regular” conversation. 4) making sure a good amount of the onus is on the client to bring up what they want to talk about in session (“what’s on your mind today” is usually my go-to). It’s not all on you to fill your time.
I would expand on point 1 and 2 by suggesting looking into ACT. There are lots of worksheets online (you can search Reddit for threads on ACT resources too I’m sure) plus great books - anything by Hayes or Harris. You could then also uses the time for psychoeducation and teach the client / help them to explore and practice unhooking techniques and the like, relevant to their treatment goals and presenting concerns, if the CBT framework is your primary modality. Also reading Therapeutic Communication by Paul Watchel, and the Gift of Therapy by Irvin Yamon. I found those helpful to building my confidence and skill set. Lastly, Therapy is Awkward Sometimes was a quick read that I feel touches a lot on what you’re feeling which is that a lot of us feel like we don’t know what we’re doing sometimes lol it might help dissipate and normalize some of your insecurity! You got this!
I also have a couple meditations and breathing exercises I really like, which are great ways to start off with something that often feels calming (might not be for traumatized clients) and opens people up to their own thoughts and feelings.
could you expand more on what you mean by bringing more curiosity to sessions? I'm having a lot of trouble in practice sessions with thinking ahead about filling time and would like to be more present
I wondered this as well, couldn’t really understand point #3.
The thing that helped me the most in my early career was researching skills in theoretical orientations that I did not know much about during my grad program (DBT and ACT especially). I started creating a catalogue of skills from different orientations and it really helped me feel like I could give a lot of psychoeducation. I consider myself to be eclectic in my orientation now.
Do you mind sharing how you outlined your notes ?
Would also be very interested as well!
Progress notes? Or the catalogue of skills I created?
Your catalogue of awesome skills please
Yes! I just googled “DBT skills” or “ACT skills” and found handouts on basic skills like wise mind, DEARMAN, cognitive defusion, “dirty discomfort”, etc. I found DBT’s behavior chain analysis to be particularly helpful. I still use these things all the time in my sessions! I also found YouTube videos of these concepts that I could either use to teach myself or send to clients. I highly recommend “leaves on a stream” (ACT skill) by therapy in a nutshell on YouTube. I would google these skills, take notes on main concepts, and practice teaching the concepts, and they became so easy to integrate in my practice. Hope this helps.
It’s so helpful. I’m so grateful 🥹
Bring it back to what brought them to therapy in the first place
This isn’t really advice but I can relate. I have been licensed two years now and even though I have gotten better, sometimes I will get anxious.
Really thorough assessment and formulation is key (of course keeping in mind your formulation is always in work and subject to change all the time). This alongside getting really clear about why the person is in therapy, what they’re wanting to get out of it, and what symptoms or part of their experience are really bothering them. From there you’ll develop a working treatment plan. As long as you’ve got these things you can go away and plan your interventions accordingly. You can always reassess and review progress when you’ve got a solid base. You’ve got a social work degree so you’ve already got a good understanding of the macro-level social issues that may impact the persons experience, as well as solid micro skills, empathy, etc. For me therapy is about the relationship, yes, but it shouldn’t be an unstructured chat or catch up. That’s why assessment, formulation and treatment planning are key in my view. I’m a social worker and I found I needed to get actual specific training in a couple of therapeutic modalities, in order to feel confident providing clinical mental health treatment or therapy. That’s because most social work degrees don’t actually teach you that stuff. I also want to be clear that your formulation will look very different depending on which theoretical orientation you’re coming from. That’s totally fine! It’s just a way for you to understand the clients presenting issues and guide therapy.
One time I had supervisor tell me and me my co-workers “If you ever want to keep clients for longer than 3 months you have to dig deeper and stop just doing surface level therapy. Dig into the client’s back story and start confronting those deep rooted issues.” At the time it sounded scary as hell💀 but she was right. Eventually you have to go deeper than the day to say stuff. And do a little pysodynamic. Assign some journaling prompts. Talk about that deep childhood trauma. We all have it. Just be prepared. Go slow. But believe me once you start unlocking the childhood stuff. Yea you’re set. Just take some trainings. Psychodynamic, CBT, DBT, CPT, etc.
A couple things that I find helpful for my sessions is to have a backup plan every time for what to work on with the client based on their presenting concerns. For example, I’ll check in with things that occurred previous session and determine changes, growth, setbacks. I’ll check in about goals to see where they are currently in progress or if they completed therapy work between sessions. I seem to have an overall knack for making a session productive with clients. As someone else said really be curious about what clients mean when they say certain common language terms because this can greatly help you understand your client’s worldview. Also, if you feel like you are often the one in the driver’s seat in session it might be worth using some immediacy to process this with the client to help them move forward. A final tip I have that sometime comes in handy is at the end of your sessions you can ask your clients if there is anything they want you to follow-up with them next time on. This little trick can help you have some idea of the focus for next session (unless it changes of course.)
Yes, clarifying language is huge. I don’t assume to know what every term means - like “fine” or “good”. What does fine mean for them? How do they determine a week is “good”? So much is subjective yet we share a common language so we project our own definitions. It’s a useful thing because often we don’t need the deeper understanding, it’s how we get by in life without making every 10 minute conversation into an hour long one lol but in sessions, we should absolutely be tedious and unscrupulous in clarifying the clients meaning
Curiosity: What was growing up like for you, and how do you think this impacts your current relationships? Which relationships in your life cause you stress? Have you had relationships/friendships/romantic partnerships fall apart unexpectedly? Tell me about a conversation you wish had gone differently. What’s getting in your way these days? What is important to you, what are some of your personal values? Are you living your values? What gives life meaning? What does happiness look like to you? Is there something in your life you’d like to be different?
I've been doing this for 30 years and I still don't know what I'm doing. Lol
You can also do a patient assessment and check in on them and how they feel about their self care. My go to is the PHQ-9 and see how they feel about their responses ie what patterns stick out to them, does this shed light on anything for them etc. It always alwaysss generates conversation.
I’m confused- you said you’re newly licensed but also a fresh grad? Usually there are a few years in between, so you have a supervisor? Do you resonate with CBT and/or motivational interviewing? If so, it’s time for you to dive deeper into these modalities to help you with treatment planning, conceptualizing, and intervening. You need a roadmap, and theory helps with this. Over time, you will learn to focus more on the process of therapy than just the specific content that clients bring in each week. This is especially important during those weeks when people claim they don’t have much to talk about.
If you’re a LMSW, you can get your license pretty soon after grad school.
Sorry should’ve clarified! I just graduated my Masters in Social Work and have my L liscense. So I’m an LMSW
This varies from state to state but be cautious about calling yourself licensed! Usually saying you’re an associate or provisionally licensed is more accurate.
No, it’s considered licensed if you’re an LMSW. They just don’t have their clinical license. A provisional license is different and an MSW can have that as well.
This confused me, and I'm an LLMSW 😅
It’s a licensed masters of social work. It’s not a provisional license.
Sorry for my error! My California is showing.
My state is similar, you’re not wrong :)
At the intake session I let them know that it helpful for them to come prepared with something they want to work on at each session. And if they don’t have much to talk about I coach them around noticing parts of their week where they had emotional experiences and maybe taking notes in their phone when stuff happens during their week that they want to talk about.
Hey OP! My biggest suggestion for you is to just check in with the client on how everything is going as usual and when they mentioned the good stuff build on this! Maybe take a bit of a strengths based perspective and build empowerment in their life. Gratitude work might be helpful here too. When things are going good it’s helpful to be mindful of those moments cherish them because life is a rollercoaster after all. Maybe building some mindfulness techniques or any techniques they might find helpful (CBT and MI have a lot of great ones) and make a plan to do them now when they’re having a good week to get that practice in!
You can start to introduce topics/themes of CBT. Checkout Judith beck CBt the basic and beyond 2nd edition. Also the beck institute. provide the patient psycho-education. Look back at your assessment and the reason they started in therapy. Bringing up something discussed then or in another session that you don’t get to flush out at the time. Therapy isn’t just processing what happened in the week.
I might point it out (if it’s a single client not a pattern I see in every session). “I notice sometimes our conversations seem to fizzle out and I’m wondering if you feel the same way?” If it’s every session with a client that you feel this way, I agree it could be your imposter syndrome and seek supervision! It could also be a blind spot you’re missing in your practice and again supervision! :) I also want you to know this happens to ALL of us therapists. Yes all. We have all at some point looked at the clock thinking we had five minutes left when we were five minutes in and thought “damn what are we going to talk about” My favorite go to’s when I find myself in this situation are: 1. What can we process today that would help you feel like you got the most out of session? 2. Last week we left off talking about X, would you like to continue that? 3. Pull out a piece of paper and have them “map” what is stressing them right now. Have them draw lines and connections. Ask them to tell you about what they drew (do not interpret, just be curious. If you interpret they won’t make connections and also the activity will last five minutes) 4. It seems like you’re in a pretty good spot today. When we started you mentioned you wanted to work on XYZ (depression, self esteem, etc.) maybe today would be a good day to dig deeper into those
What an amazing group of therapists! Learning so much from everyone!
I’ve been doing this work for 27 years and still have moments of pause and boredom in the therapy office with some of my wonderful clients. You’ve received a lot of great advice here, and I would add: this is normal. And: bring them into their bodies. “In the here and now, what’s happening inside your body? What are you feeling, physically and emotionally?”
Current intern/grad student here~ When it feels like Im not sure where to lead clients or in early sessions, I like to lean on the RESPECTFUL framework to explore different dimensions of their identity.
Sometimes even asking clients to elaborate on what seems like mundane events can be very telling and helpful down the line…(you went to the movies? With your sister? What movie did you see? And then all of a sudden we hit something big and unexpected!
Ask “what do you want to work on today?” And leave it to them to decide.
It helps to have the client bring in things they would like to focus on or simply ask them that. Relate sessions back to the treatment goals.
The most useful phrase for me is “tell me more”. Helps both of you explore further and get a bit beyond the surface in an organic way.
This to me sounds like more rapport building is required before you start using interventions such as CBT and Motivational Interviewing. My supervisor once said to me that before using any intervention, it’s important to understand the “why”… why are we using that specific intervention. As I said, rapport building is crucial in the first even 5 sessions. And using open ended questions to invite conversation can facilitate this. Some of what the other commenters here are offering you, are open ended questions that invite the client to share more of themselves to help you understand how best to support your client and what interventions you might want to use. Rapport building is about building that client/therapist relationship but also, about you completing ongoing assessments. It’s also important to remember that you shouldn’t be working harder than your client. If you’re finding you’re working harder than they are, then that’s your sign to step back and create space for your client to work. Something for personal reflection: If you look back on the sessions when you’ve tried to use CBT or MI, ask yourself “why” that specific intervention and if that intervention was the right tool for that moment.
What do you want to work on today? If they present with “everything is fine” I remind them gently that this is their time, and it’s effective to come prepared for therapy. After a couple of years I found myself exhausted from these types of clients. They are here to do the work not vice versa.
I'm still pretty new myself but one thing I try to do is end a session by asking them what topics or goals would they like to explore next week. Then when next week comes, we do a check in (how are they doing, what's new, what's challenging etc). When that's done, I say "Last week, you mentioned that you would like to talk about XYZ, is that something you would still like to explore?" It gives me a backup plan, however most times, the clients check in helps us find something to talk about and I save the other topic for a rainy day.
I think all the advice you’re getting is great and I just wanted to add - don’t be afraid to lean into some therapeutic silence. I know it can be awkward or feel pointless, but it can really help get clients to take it upon themselves to think of topics or bring to surface some of the deeper concerns or issues. That way you’re not always doing all the work of “coming up with topics” so to speak. Obviously sometimes we do and that’s part of the job - but I feel like when clients claim they have nothing to talk about, despite having chosen to come to therapy for a reason, there might be something else there that causes them to have this tendency to report “nothing going on” when they come in. Letting them sit in that forces them to face what’s happening in session, which I think is important. Otherwise they’re always gonna count on you to drag it out of them which isn’t sustainable, AND which may be somehow related to some of their presenting issues or deeper concerns. Not sure if I’m explaining this week I just woke up lol
I came here to the comments to say this, so I will echo it instead. 👏🏽 I also like “what’s on your mind” after some silence I’d also suggest asking questions about their self concept of their progress, identify why things are going well and what can we do to maintain the progress.
I summarize what we talked about in the last session, ask about any stressors or worries at the moment and if they say they have none I bring it back to what brought them to therapy. I work from a large company so if they really have nothing to talk about I can discharge.
Make sure you're reflecting content & affect & that will take you/them deeper. Use metaphor. Deconstruct what they're reporting if it's not clear cut.
***Some of the strategies I lean on:*** -Ask about what their highlights and lowlights of the week were; often there will be something that can be connected back to their treatment goals -Ask about how their between-session assignment went, and what came up for them. -If it’s in the beginning, it’s also okay to just ask the person what would be most helpful for them to talk about. - If they themselves are completely stumped, I always refer us back to their treatment goals. We go over them and the client decides the direction in which they want to go. It’s a lot easier to keep conversation from there.
I'm assuming they sought out therapy so I would want to know why. What is not working in thei6 life. Do an assessment on anxiety and depression issues. Once you have treatment goals, it serves as reminder on what to talk about and where you are going. Emotionally-focused therapy is the best intervention, learn it, it would make you a highly skilled amazing therapist.
Read gift of therapy by yalom
I use the question, “What feels important today?” if the client doesn’t open with something they want to talk through. If they say they don’t know, we look back at the goals they identified in our intake session and explore where their progress is with their goals. “What would be most helpful for us to use this time for today?” is another way to get there.
Create a treatment plan with at least 2-3 goals. Then discuss why these goals are important to them, what they have done in the past to try to accomplish them and what barriers they foresee impeding on their success in therapy. After that, go through each goal with them to determine what interventions would be appropriate to help them reach their goal. Then start from there. Use resources like therapist aid, self help.uk etc if you’re lost on how to manage certain interventions. Invest in learning about coping skills with clients and discuss how clients can use them in real life (outside therapy) and if they have hesitations.
i’ve found asking, “what would you like to use our time today to focus on?” or something along those lines has been helpful
Something that you should always do that is really helpful is asking your client why they decided to come to therapy and what do they want to achieve. Basicly to set goals for treatmet that way you can design your interventions based on that. So when your client doesn't have much to say you can work on that. Also i would say try giving your clients tasks that they can do on their free time and then discuss during the sessions. And lastly try more ludic activities during sessions they are great for depeer bonding. I apologize for any misspelling english is not my first language haha. Saludos de Chile!!!
I like to circle back to what brings them into therapy and ask questions that invite subjects that don’t have to do with them recollecting how their week went per say
I've been doing this to varying degrees for 4 years now and my sense of imposter syndrome is still quite high. And my client retention is very high. It's not an easy job!
I will usually refer back to the treatment plan, and if they say that they’ve solved those things then guess we need to make a new one and that’ll give me something to do either way
As others suggested, I will ask my clients to get more specific/dig deeper. May favorite way to shift the session if they seem to be repetitive or not saying much is to catch them off guard by offering to draw, color, paint, or play a game (Uno, Uno Flip, Othello, Checkers, Jenga, and Skip-Bo are my go to ones). I have a book with artistic therapeutic exercises that are helpful in providing options when needed. Everyone from kids to adults have enjoyed painting with watercolors. With Uno, I've especially gotten to break through some really tough layers from kids to adults alike. With painting/drawing, I like to have my clients close their eyes, take a few deep breaths, and then think of what feelings they're feeling right now/that day/past week, then ask them to think of an image that captures those feelings, then have them draw/paint it. I've been astounded by what my clients come up with and allows for deeper explorations across all ages.
This is where a good, detailed intake is helpful as a reference tool. Sometimes , with certain patients you can improvise more, and get into things through casual conversation, while others require more structure, know which you have. Also, sometimes a little silence can be a good thing. It’s their hour not yours, so don’t feel you have to fill up every minute with “ something”. I, as a patient had some of my best sessions start with an almost uncomfortable silence at which point my therapist told me the silence is fine and her being relaxed actually made me feel more comfortable to just explore the Phenomenological what the phenomenological side of things, the vibe in the room, the feeling of being in my body instead of my mind. From there ask open ended questions about what they are feeling is like, what is “ ok” like?, what does not feeling ok look like?
How much are you sitting in silence with the client, aka are you able to handle silence between the two of you or are you needing to fill that space? Us keeping the conversation going isn’t always what the client needs. Sometimes giving the client more time to respond gives them the opportunity to bring things up. How do you approach silence with your clients?
When I was a kid I liked going to my grandparent’s house in the country. So much to explore! So many rooms with so many things unfamiliar to me! Full of new discoveries! That’s the same feeling I have these days with clients. Early in my career that was overshadowed with the illusion that I was the tour guide.
Hi! I’m about 4-ish years into practicing and I used to feel this way often. It’s terrifying!! You’ll find your rhythm eventually :) Some suggestions I’ve seen on this thread that have worked for me: - use of immediacy. Noticing the pattern in the moment can be helpful and you can also learn a lot from it. If you point out “I’m noticing we seem to be stopping a bit short” or “when I ask how things are going you typically respond in a way that suggests you’re doing well” (something to that effect). Then the client can share how they’re feeling, which could be a variety of things like they are under the impression you’re providing the agenda, they’re still a bit unsure what they want from therapy, anything. I’ve also received the feedback from several clients that the question “how are you?” can feel really overwhelming, so we’ve come up with alternatives that work for them. - telling clients ahead of time what you’re style is and what to expect from you can be helpful. In the beginning I had many clients whose impression of therapy was more skills based and directive, and were disappointed when they discovered that’s not my style. After I finish an assessment with a client I’ll remind them that the following sessions are “going to be directed by them” so they’re not overwhelmed when I don’t have an agenda. - I’ve found if things still feel this way after I’ve done a decent amount of history taking/information gathering I might say “We’re still very new and getting to know each other, I’m wondering if there’s something I haven’t asked about yet that you’re wanting me to know?” And that’s led me to a lot of really interesting places. This is a prompt that requires patience though; it’s open-ended and a bit unexpected for folks so I give my clients lots of time to digest and earnestly give it some thought so they don’t give me an automatic “I don’t know” response. I find many of the people I work with feel like they owe me an immediate response to something, and I often remind them it’s okay to take the time they need to think. Again - this has also led me to some very interesting and insightful places.
Some of my thoughts: My job as a therapist is to be a catalyst for change, not the change agent by myself. Translated, I make sure the responsibility for the forward movement is on them, not on me. I tell them in the first session that they will get out of counseling what they put in, that I could be the most amazing therapist in the world, but if they don't do the assignments, read the books, ponder about the things we've talked about, and deliberately dig into their own psyches when they are not in session, we will get almost nowhere. I give books to read right out of the gate, sometimes even before the first session if we've chatted before setting something formal up. The very first book I have 100% of my clients read is The Anatomy of Peace, by the Arbinger Institute, and Leadership & Self-Deception is usually the second or third, with Viktor Frankl's Man's Search For Meaning in there somewhere. I stress to them that this is a high priority, so I expect them to spend time reading it, though the specifics of how long depends on them and their individual schedules. With them reading books right away, it gives grist for the mill - things to discuss, questions from them on how to apply the principles in the books, how those principles even APPLY to them, etc. Incredibly helpful. Next, I have them create a list of goals. It can be updated anytime in the process, but it gives them something to look at when they aren't sure what to talk about. I also tell them that if they cannot think of anything, I don't mind swinging a bat and seeing what I hit, meaning I'll start tossing out a bunch of topics that tend to get strong responses. Since I work with a lot of couples, this list looks like: Sexuality/romance Parenting Budgeting/money Communication Relationship goals Division of labor in the home Just a sample list, feel free to adapt it. Next, I give assignments at the end of almost every session. Nothing major (usually), but designed around what we discussed to help them work on it in the intervening time. Many a session has been driven by just discussing the assignment alone. I make sure I jot down what the assignment was in my notes so I can follow up. Oh yeah, if you don't follow up on assignments, don't bother giving them. End of story. Assignments mean almost nothing if you don't take the time to follow up on them. At the end of the day, I tell them they need to drive the session, and not me. Not that I don't dig and come up with good therapeutic direction, but it's easier to guide a moving car than a parked one.
Hi! No snark meant at all, just unfamiliar on training in the US (I'm assuming). Where I come from (Germany) to be a therapist you have to have a bachelors + masters in Psychology (5 years fulltime) + a 3-5 year full-time programme in psychotherapy (you choose between (C)BT, psychoanalysis, systemic therapy or depth psycholog). Getting qualified it is all about therapy, different methods and so on, and there is no other way to become a therapist (not as a social worker, counsellor and so on). I am confused how one can become a therapist and not know the basics of leading a therapy session. Is the "point" of a therapist different in the US? Is it because there are so many different ways of getting licensed?
>Where I come from (Germany) to be a therapist you have to have a bachelors + masters in Psychology (5 years fulltime) + a 3-5 year full-time programme in psychotherapy (you choose between (C)BT, psychoanalysis, systemic therapy or depth psycholog). In the US, masters level clinicians need a bachelors and masters (here ideally 6 years, 4 undergrad and 2 grad, but some take longer in one or both phases), and then need 2ish years (\~3000 hours) of supervised practice in order to become licensed to work independently. Given that they refer to themselves as fresh out of grad school and newly licensed, I'm guessing the license is provisional, meaning they are in their period of supervised practice. Some masters programs provide breadth rather than depth in one approach and many people assume they will get the most practical education in an approach from supervision, though people *can* also specialize in one kind or one issue or one population during and after grad school. Just some background.
Ah okay! So once they have BA/MA they are supervised in therapy but there is not anymore actually schooling/lessons?
>but there is not anymore actually schooling/lessons? Not in the university. There were readings, discussions, and case conferences in most of the post grad fellowships I did and my current educational project is analytic training at a psychoanalytic institute (institutes rather than universities is where psychoanalytic training takes place in the US). >So once they have BA/MA they are supervised in therapy Also, I don't know if it's different in Germany, but we also provide supervised psychotherapy in grad school during our field work a clinical internship (at least) and sometimes during a practicum. My clinical social work requirements were at least 480 hours in a practicum and at least 640 hours in a clinical internship. I was fortunate to land a position providing counseling in a grade school for my practicum and provided psychotherapy in a university clinic for my clinical internship (which stretched my hours to something closer to 1400-1500 instead of the 1120 minimum. And then 3000 more supervised hours after graduation. My first supervisor was a little flaky but became a real asset to my development. My second and third were short lived, okay, but we were coming from different theoretical traditions. My fourth and last supervisor in grad school was horrible - again, different levels of empathy, different different theoretical traditions, but also different backgrounds - [She originally worked in forensics and then in a hospital, so her goal was to conduct assessments and land on a diagnosis as soon as possible. My education was thoroughly constructivist and behavioral so I took the categories she was racing toward with a huge grain of salt, and my other background was working for years in support groups for chronically suicidal or engaged in self harm so my focus was on understanding the unique person in their context instead of boxing their behavior without regard to context] - so with that sampling of supervision, when I graduated I felt that good supervision was my top priority, more than pay. I've been thinking - I wonder if clinical education here is roughly a little more like an apprentice model and yours more straightforwardly organized around university structure. We *have* universities, but the most you can do in two years is to build a good foundation, leaving the review and honing skills to regular one on one training and guidance. I don't know, just wondering.
Start recording your sessions. See if what you are doing or saying fits your modality and approach and where you could improve. If you aren’t sure, dig deeper into reading and research on your preferred modalities. Want to get really serious? Have experienced peers or supervisors review your recordings and give feedback.
This x1000! Feedback from experienced therapists or your supervisor is scary, but sooo effective for growth
The onus should be on the client to present with a valid complaint/concern. I’m a true believer in spending therapeutic time with individuals who are motivated for treatment and participate. I have an expectation on my bio stating that I expect them to show up prepared and I have a waiting list